Friday, August 14, 2015
In a recent article for the University of Baltimore Law Review, John C. Craft, a clinical professor at Faulkner University Law, draws upon the history of legislation governing powers of attorney to advocate a return to effectiveness of the POA being conditioned by an event, such as proof of incapacity. Professor Craft, who is the director of his law school's Elder Law Clinic, writes:
Section 109 in the Uniform Power of Attorney Act should be revised making springing effectiveness of an agent's powers the default rule. Springing powers of attorney provide a type of protection that may actually prevent power of attorney abuse. The current protective provisions in the UPOAA focus in large part on the types of abuse that occur after an agent has begun acting for the principal. As opposed to arguably ineffective “harm rules” intended to punish an unscrupulous agent, springing powers of attorney are a type of “power rule” intended to limit an agent's “ability to accumulate power . . . in the first place.” The event triggering an agent's accumulation of power -- the principal's incapacity -- may never occur. A financial institution may prevent an unscrupulous agent from activating his or her power and conducting an abusive transaction simply by asking for proof that the principal is incapacitated. In addition, making springing effectiveness the standard serves the goal of enhancing a principal's autonomy.
For his complete analysis, read Preventing Exploitation and Preserving Autonomy: Making Springing Powers of Attorney the Standard.
August 14, 2015 in Advance Directives/End-of-Life, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Legal Practice/Practice Management, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)
At the 2015 White House Conference on Aging on July 13, 2015, during the discussion from the first panel on Empowering All Generations: Elder Justice in the Twenty-First Century, one panelist from Minnesota mentioned dementia-friendly communities and the Dementia-Friendly America initiative. Six cities were mentioned as examples. Minnesota has a website that offers many tools on making a community dementia-friendly or dementia-capable. A dementia-capable community is "[a] dementia capable community is informed, safe and respectful of individuals with the disease, their families and caregivers and provides supportive options that foster quality of life." The toolkit is available here.
Thursday, August 13, 2015
Earlier this summer, a North Carolina appellate court reversed a trial court's finding that "membership fees" tied to condominium purchases in a retirement community were "unconscionable." In a class action suit filed by residents against Cedars of Chapel Hill LLC., this summer's ruling permits the defendant company to continue to market and sell its retirement condos as "fee simple" units in combination with "continuing care member" contracts, although the court also remanded for a jury trial before the lower court.
In a highly technical ruling that examined state real estate transfer fee rules, the North Carolina's marketable title act, and arguments under the common law about unequal bargaining power, the appellate court rejected summary judgment in favor of the residents. The court addressed allegations of both procedural and substantive unconscionability in the contracting process. The court explained in part:
Substantive unconscionability “refers to harsh, one-sided, and oppressive contract terms.” … The terms must be “so oppressive that no reasonable person would make them on the one hand, and no honest and fair person would accept them on the other.” Brenner v. Little Red Sch. House Ltd., 302 N.C. 207, 213, 274 S.E.2d 206, 210 (1981). Plaintiffs, in raising this issue, contended that the fees in question were “exorbitantly high,” that the documents at issue were “decidedly one-sided in favor of the Company,” and that plaintiffs lacked “ability ... to negotiate any of the terms of the covenants and conditions in question in this case.” Plaintiffs further noted that the market for CCRCs in Chapel Hill is very small, leaving few alternatives.
…[W]e find plaintiffs' arguments unavailing. We recently held that “the times in which consumer contracts were anything other than adhesive are long past.” Torrence v. Nationwide Budget Fin., ––– N.C.App. ––––, ––––, 753 S.E.2d 802, 812 (quoting AT&T Mobility LLC v. Concepcion, –––U.S. ––––, ––––, 131 S.Ct. 1740, 1750, 179 L.Ed.2d 742, 755 (2011)), review denied, cert. denied, 367 N.C. 505, 759 S.E.2d 88 (2014). The mere fact that plaintiffs lacked the ability to negotiate contract terms does not create substantive unconscionability, nor does the fact that defendants were among the only providers of CCRC facilities. We hold that plaintiffs did not adequately demonstrate unconscionability as a matter of law, and that a genuine issue of material fact existed as to unconscionability, which precluded summary judgment.
For more of this ruling, see Wilner v. Cedars of Chapel Hill LLC., 773 S.E 2d. 333 (N.C. Ct. App., 2015).
For reactions from the parties' representatives, see NC Appeals Court Ruling Favors Cedars of Chapel Hill Condo Fees.
For an additional, interesting discussion of business perspectives on retirement developer control, written prior to the most recent appellate court ruling, see Two Pitfalls of Leveraging Developer Influence, from a North Carolina law firm blog.
This case -- revealing the range of complexities in contracts for senior housing and services -- is another example of why I added "Contracts" law to my teaching package, with elder law!
Wednesday, August 12, 2015
The Pew Research Center released a map showing the aging of America by county. Where do the oldest Americans live? provides a map of the U.S. that shows the percentage of a county's population 65 and older. As the website explains, due to the aging of the Boomers and increased longevity,
more counties across America are graying. A new Pew Research Center analysis of the Census Bureau’s 2014 population estimates finds that 97% of counties saw an increase in their 65-and-older population since 2010.
On average, a U.S. county’s 65-and-older population grew by 12.4% from 2010 to 2014. (Our analysis of population change over time included only counties or county equivalents with a population of 1,000 or more adults ages 65 and older in 2014.)
And yes, Florida is still one of the "grayest" states, with 3 Florida counties ranking in the top 4 of the grayest counties. The report notes as well that some states are getting "younger" with
a tiny share of counties (3%) saw a drop in the 65-and-older demographic since 2010. Oklahoma’s small Alfalfa County, on the Kansas border, had the highest rate of decrease in the 65-and-older population, at 9.5%... North Dakota ... had two counties, Williams and Wells, rank among the top five for rate of decrease of adults 65 and older. Three counties experienced no change since 2010... Alaska is the “youngest” state based on its share that is 65 and older (9.4%). Fully 26 of 29 Alaska counties have percentages of people 65 and older that fall below the U.S. average.
Mary Jane Ciccarello, co-director of the Borchard Center on Law and Aging, recently sent us the latest news on the fellowships announced for the 2015-16 grant year. There is strong competition for these key sources of funding for recent law school graduates to engage in new or expanded initiatives in law and aging. The new fellows include:
- Krista Granen, a 2015 University of California-Hastings graduate, who will partner with Bay Area Legal Aid in San Francisco to implement a multi-faceted project to provide direct services, establish a mobile “pop-up” clinic to accommodate seniors’ physical and capacity based impairments, and promulgate resource materials in the intersectional areas of consumer protection and Social Security. Her project will promote economic security for low-income seniors residing in Santa Clara County, a county that simultaneously experiences extreme class stratification and a dearth of necessary legal services.
- Jennifer Kye, a 2014 UVA graduate, at Community Legal Services of Philadelphia, who will implement a three-part project focused on increasing vulnerable seniors’ access to Medicaid home and community-based services. Her project will include: (1) systemic advocacy at the state level to expand the availability and improve the delivery of these critically needed home-based services; (2) development of a self-help manual that will allow seniors to advocate for themselves in accessing services in their own homes; and (3) direct representation of low-income older adults in obtaining and keeping home-based services and supports.
- Stephanie Ridella Vittandsm, a 2014 Chicago-Kent graduate, who will continue her work at the Chicago Center for Disability and Elder Law, advocating for low-income seniors in housing matters, including eviction defense, public housing voucher termination defense, and representing seniors evicting tenants or family members from their homes. By prioritizing time-sensitive housing cases and conducting expedited intake interviews, she can continue to intervene in emergency housing cases. She will continue to administer the Pro Se Guardianship Help Desk, which provides assistance to petitioners seeking guardianship over family members.
- Shana Wynn, a 22015 graduate of North Carolina Central Law School, who joins Justice in Aging (formerly the National Senior Citizens Law Center) and the Neighborhood Legal Services Program (NLSP) in Washington, DC. Ms. Wynn will work closely with Justice in Aging attorneys to formulate policy recommendations to improve the Social Security Administration’s (SSA) representative payee program for Supplemental Security Income (SSI) recipients and Social Security beneficiaries. Ms. Wynn will partner with NLSP to provide pro bono services to low-income seniors and secure access to healthcare and public benefits such as SSI. The primary goal of the project is to identify and address problems relating to SSA’s representative payee program as a means to better protect our most vulnerable seniors from misuse of their modest incomes.
August 12, 2015 in Discrimination, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Grant Deadlines/Awards, Health Care/Long Term Care, Housing, Legal Practice/Practice Management | Permalink | Comments (1)
Tuesday, August 11, 2015
To view the relationship between health care quality and spending in your state or local area, use the graph, known as a scatter plot, or map. Choose a health care setting, such as hospitals, and then a quality measure to view performance. Curious about how your region compares to someplace else? Click on your selected location and then drag your mouse to the state or local area you want to compare it to and hover. You can see which location has lower spending and higher quality relative to the U.S. median.
Avenging angels or unholy alliance? A lawsuit filed by the New Mexico Attorney General in December 2014 against Preferred Care Partners Management Group, a large, privately held management company operating nursing homes in New Mexico and nationally, raises interesting questions about whether AGs should be teaming with private lawyers to pursue cases of alleged malpractice, abuse or fraud affecting consumers. The Plano, Texas-based defendant asserts that "lobbying" of state attorney generals by private firms to pursue questionable claims is improper, pointing to campaign contributions paid by law firms or individual lawyers, as well as contingent fee arrangements that defendants argue reduce the States' accountability.
Current Attorney General Hector Balderas blasted back at the company through a spokesman. “Bilking taxpayers for inadequate care and denying helpless and vulnerable residents basic services will not be tolerated,” he said. “Our office will continue to aggressively protect New Mexico’s taxpayers and our most vulnerable populations.”
Currently, the New Mexico case is in federal court, following the defendant's removal from the original filing in state court. The law suit -- and the issue of private/public partnerships in pursuing claims on behalf of consumers and/or taxpayers -- is generating a lot of attention in the business world. Recent coverage includes linked news stories by the New York Times, the Albuquerque Journal, and McKnight's LTC News.
August 11, 2015 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink
Monday, August 10, 2015
The Department of Justice, Civil Rights Division, Disability Law Section has released an FAQ on service animals and the ADA. The 37 FAQ, Frequently Asked Questions about Service Animals and the ADA runs the gamut from definitions to general rules, to breeds of dogs, to exclusions, to certifications and registrations, and more. DOJ offers this introduction to the FAQ:
The Department of Justice continues to receive many questions about how the Americans with Disabilities Act (ADA) applies to service animals. The ADA requires State and local government agencies, businesses, and non-profit organizations (covered entities) that provide goods or services to the public to make "reasonable modifications" in their policies, practices, or procedures when necessary to accommodate people with disabilities. The service animal rules fall under this general principle. Accordingly, entities that have a "no pets" policy generally must modify the policy to allow service animals into their facilities. This publication provides guidance on the ADA’s service animal provisions and should be read in conjunction with the publication ADA Revised Requirements: Service Animals.
Charlie Sabatino, Executive Director of the ABA Commission on Law & Aging (COLA), former NAELA president, great guy and good friend of mine, forwarded to me the announcement about the Impact Fund. According to the announcement,
The Impact Fund provides grants to nonprofit legal firms, private attorneys, and/or small law firms working to advance social justice in the areas of civil and human rights, environmental justice, and poverty law.
Through the fund’s litigation program, grants of up to $25,000 will be awarded in support of public interest litigation that has the potential to benefit a large number of people, lead to significant law reform, and raise public consciousness of social justice issues. The fund is particularly interested in projects that address systemic deprivations of constitutional or statutory rights in post-9/11 cases involving denial of rights under the guise of "homeland security"; criminal justice and immigration; and education access and equity.
For the fall cycle, Letters of Intent are due by August 13, 2015 with the next round for full applications for selected applicants due September 3, 2015. Information about the grant application requirements is available here. Grants are awarded quarterly, with relevant deadlines here. Information about previously awarded grants can be accessed here.
The Public Policy Institute (PPI) of California recently profiled demographic changes likely to affect that state in coming decades, including the impact of a projected increase, to 20%, of the proportion of the population aged 65+. One especially interesting component is the impact of seniors who are likely to be "single," especially those without the assistance of children, spouses, or other close family members, a trend that seems likely to be true nationwide. From PPI's report (minus charts and footnotes):
Family structures in this age group will also change considerably—in particular, marital status will look quite different among seniors in 2030 than it does today.... The fastest projected rates of growth are among the divorced/separated and never married groups. Between 2012 and 2030, the number of married people over age 65 will increase by 75 percent—but the number who are divorced or separated will increase by 115 percent, and the number who are never married will increase by 210 percent....
Another significant change will be in the number of seniors who have children. Those who have never been married are much less likely to have children than those who have been married at some point. As a result, seniors in the future will be more likely to be childless than those today.... In 2012, just 12 percent of 75-year-old women had no children. We project that by 2030, nearly 20 percent will be childless. Since we know that adult children often provide care for their senior parents, these projections suggest that alternative non-family sources of care will become more common in the future.
Thus, just as we're making noise about supporting seniors' preference to "age at home," we may be over-assuming that family members will be available to provide key care without direct cost to the states. Hmmm. That's problematic, right?
More from the California PPI report, including some conclusions:
California's senior population will grow rapidly over the next two decades, increasing by an estimated 87 percent, or four million people. This population will be more diverse and less likely to be married or have children than senior are today. The policy implications of an aging population are wide-ranging. We estimate that about one million seniors will have some difficulties with self-care, and that more than 100,000 will require nursing home care. To ensure nursing home populations do not increase beyond this number, the state will need to pursue policies that provide resources to allow more people to age in their own homes....
The [California In-Home Service & Supports] IHSS program provides resources for seniors to hire workers, including family members, to provide support with personal care, household work, and errands. One benefit of hiring family members is that they may provide more culturally competent care. Medi-Cal is already the primary payer for nursing home residents, and the state could potentially save money by providing more home- and community-based services that support people as they age, helping to keep them out of institutions. Finally, the projected growth in nursing home residents and in seniors with self-care limitations will require a larger health care workforce. California’s community college system will be a critical resource in training qualified workers focused on the senior population.
The San Diego Union-Tribune follows up on this theme in California Will Have More Seniors Living Alone, by Joshua Stewart.
August 10, 2015 in Consumer Information, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Retirement, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Friday, August 7, 2015
In the wake of devastating reports about poor accountability following inspections of nursing homes in Pennsylvania under a previous governor, plus a new civil lawsuit filed by the Pennsylvania Attorney General's office, the current Pennsylvania Secretary of Health has announced a state task force to study certain issues.
According to the state press release, the task force "will be charged with identifying ways the department can advance quality improvement in Pennsylvania's long-term care facilities. The goal is to review current regulations and identify areas that the department may improve to ensure that nursing homes are operating at the highest level regarding the quality and safety of their residents."'
The Secretary's office indicates that in addition to "members of the Governor's Office, the secretaries of the Pennsylvania departments of Aging, Human Services, and State," appointed task force members include:Jaqueline Zinn, PhD - Temple University (Business School)
Mary Naylor, PhD, FAAN, RN - University of Pennsylvania (Nursing, Gerontology)
Steven Handler, MD - University of Pittsburgh (Medical School, Biometric Informatics)
Rachel Werner, MD, PhD - University of Pennsylvania (Medical School, Quality of Care)
Dana Mukamel, PhD – University of California, Irvine (Public Health, Quality of Care)
David Grabowski PhD - Harvard University (Medical School, Health Care Policy)
Barbara Bowers RN, PhD, FAAN - University of Wisconsin (Institute of Aging, Long Term Care)
Pennsylvania State Senator Pat Vance
Pennsylvania State Representative Mathew Baker
On the positive side, it is good to see non-Pennsylvanians appointed to the team, all with excellent credentials. Perhaps on the less positive side, it seems to be a very large team, made up mostly of very prominent but busy "volunteers," two factors which in my experience can reduce efficiency.
For news accounts of the potential political factors that may be play in this recent history, see here and related articles linked below.
August 7, 2015 in Consumer Information, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink
PBS ran a brief story in July as part of its Rundown blog regarding the variations in costs of long-term care by state. Long-term care costs vary greatly by state and type uses the Genworth 2015 Cost of Care Survey for the story. If you haven't reviewed the Genworth Survey results, do so. It's a useful tool for your students to understand the various costs of different types of long-term care.
Thursday, August 6, 2015
From a recent NPR piece on Knowing How Doctors Die Can Change End-of-Life Discussions:
Dr. Kendra Fleagle Gorlitsky recalls the anguish she felt performing CPR on elderly, terminally ill patients. It looks nothing like what we see on TV. In real life, ribs often break and few survive the ordeal.
"I felt like I was beating up people at the end of their life," she says. "I would be doing the CPR with tears coming down sometimes, and saying, 'I'm sorry, I'm sorry, goodbye.' Because I knew that it very likely not going to be successful. It just seemed a terrible way to end someone's life."
Gorlitsky now teaches medicine at the University of Southern California and says these early clinical experiences have stayed with her. Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.
This selection also reminded me about an important essay from a few years ago, How Doctors Die, by Dr. Ken Murray. Hat tip to my Dickinson Law colleague Professor Laurel Terry for sending me this NPR piece.
[t]he ratings are based on agencies’ assessments of their own patients, which the agencies report to the government, as well as Medicare billing records. The data is adjusted to take into account how frail the patients are and other potential influences. Medicare intends to use the same or similar data sources when it eventually begins to pay bonuses and penalties to agencies based on performance, as it does for hospitals.
According to Medicare's blog, HHAs are rated in 9 categories, including wound care and prevention of bed sores, handling daily activities, controlling pain, and protecting the patient from harm. To learn more, click here to visit the HHA Compare website.
Wednesday, August 5, 2015
In recent weeks, I've been doing background research on "cross-border retirement" issues and therefore I was interested to read that ElderLawGuy Jeffrey Marshall's brother has retired to Mexico and "loves it."
For some, the reasons may include comparative costs for a range of services, including support for "independent" living, or more skilled care, as documented by the PBS News Hour program on "Why Foreign Retirees Are Flocking to Mexico." The program interviews retirees in central Mexican communities near Lake Chapala. The program compares "average cost for independent living" in U.S. retirement communities of "about $2,500 per month, with one Mexican community's prices for "rent, all utilities, connections for internet, television ... plus three meals a day" at "just a little over $1,000 a month."
But, as the program touches on (only briefly), Medicare benefits don't apply in Mexico (although, perhaps they should?). And there are also important questions about reciprocity in care for Mexican retirees who may have spent many working years in the U.S.
I was reading a blog post from Aging in Place Technology Watch which offered a roundup of tech announcements coming out of the 2015 White House Conference on Aging. I was intrigued by the UberAssist project which according to the announcement on Uber's website
Today, Uber will participate in the White House Conference on Aging and discuss Uber’s efforts to engage the senior community. At the event, we will announce the launch of a pilot program for community-based senior outreach. In cities across the country, Uber will offer free technology tutorials and free rides at select retirement communities and senior centers. Alongside public and private sector representatives, we hope to further the conversation about the way technology adoption can improve older adults’ day-to-day lives.
Uber has some projects going in Florida, for example, in Gainesville, Uber
is working with the City ... to offer on-demand transportation for residents of two senior centers as part of a six month program. Anytime a resident at a participating senior center needs a ride, he or she can request one at an even more affordable rate because of support from the city. Free technology tutorials will be available throughout, so residents of the participating centers can feel comfortable and at ease using Uber. Uber is also piloting a similar senior ride program in partnership with the Town of Miami Lakes.
a unique new collaborative research and development initiative for open innovation that will examine and share solutions for aging well. The initiative will identify new technologies, products and services, as well as provide thought leadership in collaboration with older adults, caregivers, healthcare systems, payers, policy makers, corporate innovators, entrepreneurs and academia. The AWH will also seek solutions to improve technology adoption among older adults and make aging well a reality for more people, by enabling them to better connect with their communities and healthcare providers.
You can read all of the WHCOA partner press releases and announcements here.
Tuesday, August 4, 2015
I, along with many academics, have appreciated the opportunity to travel more easily to Cuba (my first working visit was in June). It will be fascinating to see what academic programs emerge, including opportunities for comparative law studies. Along this line, it was was interesting to read a Washington Post article about plans of several colleges and universities, including University of District of Columbia Law School's announcement of a week-long session in January 2016 for study of "issues around aging," including, apparently, the dean's interest in filial support enforcement in Cuba.
My thanks to Kate Manni, an administrator from Penn State's Office of Global Programs, for sharing the Post's article.
The New York Times ran a story on July 17, 2015 on how scammers are targeting older individuals on internet dating sites. Swindlers Target Older Women on Dating Websites tells the stories of several elders who ended up sending significant sums of money to scammers who had developed virtual relationships with these elders. This high-tech version of the "romance con" has resulted in the legislature in at least one state, Vermont, to consider "pass[ing] a law requiring online dating sites to notify members quickly when there is suspicious activity on their accounts or when another member has been barred on suspicion of financial fraud." As well, the story explains, the proliferation of the virtual version of the romance con was the impetus for action from AARP.
Despite warnings, the digital version of the romance con is now sufficiently widespread that AARP’s Fraud Watch Network in June urged online dating sites to institute more safeguards to protect against such fraud. The safeguards it suggests include using computer algorithms to detect suspicious language patterns, searching for fake profiles, alerting members who have been in contact with someone using a fake profile and providing more education so members are aware of romance cons.
The AARP network recommends that from the beginning, dating site members use Google’s “search by image” to see if the suitor’s picture appears on other sites with different names. If an email from “a potential suitor seems suspicious, cut and paste it into Google and see if the words pop up on any romance scam sites,” the network advised.
On AARP's site, individuals can learn more about these digital romance cons, sign an on-line petition to dating sites to adopt safety measures, and learn 10 tips on how to spot a romance scammer and 5 tips to protect oneself from this "virtual heartbreak".
Monday, August 3, 2015
The Arizona Republic recently reported on Arizona legislation affecting home care agencies that will become effective in 2015, after a similar bill was vetoed in 2014 by a previous governor. According to news reports, the new law requires agencies to disclose to consumers whether they do background checks on employees, what type of training they use for employees, the costs of services and their hiring and firing practices.
In my experience, such a "disclosure" focus is different than setting minimum substantive standards for home care, and puts a great deal of responsibility for evaluation of "disclosed" information on consumers, who when it comes to long-term care, may already be under stress.
"We want to help the consumer understand better and make an educated decision," said Mark Young, president of the Arizona In-Home Care Association (AZNHA) who helped press for passage of the bill. "A lot of times, clients get in crisis mode when they need to make these decisions because they don't know about the industry."
The bill, sponsored by Sen. Nancy Barto, R-Phoenix, passed unanimously in the Senate and by a 51-8 margin in the House. Gov. Doug Ducey signed the bill into law April 1.
Home-care service owners could be charged with a misdemeanor if their company does not comply with the new regulations, the attorney general's office said. But the law does not apply to volunteer caregivers and home-care service organizations already licensed by the state or federal government.
The Administration for Community Living (ACL) has posted a new report on its website. The July 2015 report was prepared by RTI International pursuant to a contract with ACL. The report is titled IDD and Dementia. The executive summary explains in part:
The National Plan to Address Alzheimer’s Disease (2014) calls for a coordinated effort to develop workforces in aging, public health, and intellectual and developmental disabilities that are dementia-capable and culturally-competent. In response to this directive, the U.S. Administration on Community Living presents the findings and resources in this white paper to community of providers who primarily serve older adults. It provides a broad overview of the services and support system for persons with intellectual and developmental disabilities (IDD) affected by dementia and their caregivers, examples of cross-network initiatives, and resources for improving dementia care across agencies and organizations that serve this population.
This white paper presents the current state of services and support system for persons with IDD who have dementia. There is recognition in the aging and IDD networks that states are in a transition period where the future of services will be more person-centered and focused on integration in the community (see Appendix A).
The report is divided into 9 sections with section 4 looking at screening, diagnosis and treatment; section 5 looking at services and financing; and section 6 looking at efforts to improve community-based services. Section 7, the conclusion, includes a brief discussion of 5 issues:
Is dementia awareness education available to the IDD population and service providers?
Do the information and assistance services in both the aging and IDD networks identify those individuals with IDD and dementia and their caregivers who contact them?
Are persons with IDD and dementia being referred for appropriate diagnosis?
Are program eligibility and resource allocations taking into account the impact of cognitive disabilities on an aging population of persons with IDD?
Are the dementia-capable home and community-based services available to the general population capable of serving persons with IDD and dementia?
The report is available here.